Therapeutic drug monitoring in patients with tuberculosis and concurrent medical problems

Anne-Grete Martson, Gena Burch, Samiksha Ghimire, Jan-Willem C. Alffenaar, Charles A. Peloquin*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

30 Citations (Scopus)
419 Downloads (Pure)

Abstract

Introduction

Therapeutic drug monitoring (TDM) has been recommended for treatment optimization in tuberculosis (TB) but is only is used in certain countries e.g. USA, Germany, the Netherlands, Sweden and Tanzania. Recently, new drugs have emerged and PK studies in TB are continuing, which contributes further evidence for TDM in TB. The aim of this review is to provide an update on drugs used in TB, treatment strategies for these drugs, and TDM to support broader implementation.

Areas covered

This review describes the different drug classes used for TB, multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), along with their pharmacokinetics, dosing strategies, TDM and sampling strategies. Moreover, the review discusses TDM for patient TB and renal or liver impairment, patients co-infected with HIV or hepatitis, and special patient populations - children and pregnant women.

Expert opinion

TB treatment has a long history of using 'one size fits all.' This has contributed to treatment failures, treatment relapses, and the selection of drug-resistant isolates. While challenging in resource-limited circumstances, TDM offers the clinician the opportunity to individualize and optimize treatment early in treatment. This approach may help to refine treatment and thereby reduce adverse effects and poor treatment outcomes. Funding, training, and randomized controlled trials are needed to advance the use of TDM for patients with TB.

Original languageEnglish
Pages (from-to)23-39
Number of pages17
JournalExpert Opinion on Drug Metabolism & Toxicology
Volume17
Issue number1
DOIs
Publication statusPublished - 2-Jan-2021

Keywords

  • Therapeutic drug monitoring
  • tuberculosis
  • mdr-TB
  • pharmacokinetics
  • pharmacodynamics
  • MULTIDRUG-RESISTANT TUBERCULOSIS
  • 1ST-LINE ANTITUBERCULOSIS DRUGS
  • LIMITED SAMPLING STRATEGIES
  • PARA-AMINOSALICYLIC ACID
  • POPULATION PHARMACOKINETICS
  • MYCOBACTERIUM-TUBERCULOSIS
  • IN-VITRO
  • CLINICAL PHARMACOKINETICS
  • LINEZOLID EXPOSURE
  • TREATMENT OUTCOMES

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